The person appears blotchy immediately after acne surgery, and it takes one to two days for that to resolve. I always ask the patient about upcoming social events or photo sessions over the next several days before initiating acne surgery.

If anaphylaxis or severe urticaria develops, one can use epinephrine 1:1,000, and the dose should be 0.01 cc's per kg injected into the subcutaneous fat, and that should be repeated every 10 to 15 minutes as necessary until the eruption is under...

If the patient is on beta-blockers, generally epinephrine will not work in anaphylaxis. Glucagon can be administered in its place, and 1 mm of glucagon can be given subcutaneously irrespective of body size. Nausea is the major side effect.

Atrophy of facial skin induced by overuse of topical steroids to facial skin. The vessels of the deeper dermis and fat can be seen through the thin epidermis/dermis. Upon cessation of use of the steroids, the skin should regain its normal...

Basal cell carcinoma. This patient had spent her younger years in Chihuahua, Mexico, and had been exposed to a lot of sunlight as a young person. This basal cell carcinoma originated within the epidermis and extended through the skin fat, and...

The two ellipses were joined into a long ellipse, and layered closure was done. 4-0 absorbable suture (Vicryl) was used for the deep dermals, and 4-0 monofilament (Prolene) was used for the superficial running suture. Note the eversion of the wound.

This person had a basal cell carcinoma, and the epidermis and dermis were excised. The danger area where the temporal branch of the facial nerve may lie and be quite close to the undersurface of the skin is shown by the straight lines drawn from...

Benign nevus in a child. It has been found that if a nevus grows rapidly in a child that this is the most common indicator of melanoma, and is more important than the usual criteria of mixture of colors and/or jagged border.

Body lice often are located in the seams of the clothing. The treatment is simply physically washing the lice off the body, and destroying them within the clothing by washing them in hot water or dry-cleaning them. Itching can be relieved with the...

This is the back of the patient who was infested with chiggers. Treatment consists of any of the following:1) topical steroids applied twice daily.2) oral antihistamines.3) on prednisone, 1 mg/kg per day until the itching resolves.

Same child with scabies showing the lesions in the web spaces, around nipples, umbilicus, and suspected lesions should be scraped with a curette or a #15 scalpel blade, and mineral oil is applied first to ensure that the scale tends to adhere to...

This patient with more than 10 red papules and pustules is using one of the two topical programs shown: 1) Program on the left is Cleocin-T lotion applied twice daily, and Retin-A 0.025% cream applied at night. 2) Program on the right is...

The second step in the Bezzant method is to poke a hole in the top of the comedo or papulopustule with a small gauge needle, such as a 30 gauge. This provides an exit for the material so that it will eject from the skin and not be extruded into...

The topical antibiotic and non-adherent dressing are secured in place with tape or a cotton gauze wrap. The third principle of wound care is to ensure good nutrition, and the most important element of that would be to keep pressure off the wound,...

This demonstrates the placement of the deep dermal suture. Note that the deep dermal suture is placed as far away from the wound edge as possible to avoid compromise of blood flow to the wound. This demonstrates the exit of the deep dermal suture...

This is a biopsy of dermatitis. The epidermis (upper purple strip) is being infiltrated by lymphocytes (small purple dots), and they are also infiltrating into the dermis (lower pink area). The consequence of this lymphocytic attack is disruption...

This biopsy demonstrates basically what is happening within dermatitis. Lymphocytes (small purple dots) are attacking the epidermis (thick upper purple area), as well as the underlying dermis (fainter pink area at the base) and induce abnormal...

Dr. Maxwell M. Wintrobe told us as medical students to put ourselves in the position of the patient and try to imagine what it would be like to be the recipient of some of the procedures that we do to them. He was a great advocate of empathy.

Very light electrocautery can be used to smooth any uneven edges. If using the hyfrecator model, it should be plugged into low and a setting of 30 on the older machines, or setting of 3 watts on the newer machines should be used, and a very light...

Standard epinephrine (1:1,000) is shown at the top, and the crystalline form (Sus-Phrine) is a concentration of 1:200. Both are administered into the subcutaneous fat, and a dose of epinephrine 1:1,000 is 0.01 cc's per kg, and the dose of...

If a patient is on beta-blockers and experiences severe urticaria or anaphylaxis, often epinephrine does not work. Glucagon can be used in lieu of epinephrine, and generally 1 mg (regardless of body size) is given in the subcutaneous fat

This shows eversion of the wound on the face of a young man. Most of the eversion is created by the deep dermal suture, and not by the superficial sutures shown here. The upper epidermis and dermis were closed here using 4-0 Prolene. It simply...

This shows a top view of the same wound, and the marked eversion. The reason eversion is achieved is that the forces acting on the wound are downward (as the scar contracts), and laterally from the natural tension created by the surrounding skin....

This suture is tightened by crossing the non-dominant (left) and over the dominant (right) hand. This same sequence is continued until four loops have been thrown and then the suture is cut leaving ends approximately .5 cm long.

Undermining is achieved by using scalpel or scissors to free the dermis from the fibrous septae that connect it to the underlying fascia. One undermines the wound until the wound edges pull together readily.

The needle holder is placed on the inside the long arm (needle bearing end) of the V as shown. Before beginning to tie the knot, insure that the two ends of the suture come out the same side of the loop, and that the order is: loop, short...

The suture is tightened by pulling the suture with the hands ending in natural position. The knot tying procedures previously shown are done twice more until the four throws have been placed. Suture is then cut just above the knot. Deep dermals are...

The double loop is tightened by pulling the hands into their natural position, but the knot cannot be adequately tightened by pulling in that direction; the knot must be tightened by pulling the suture ends along the length (long axis) of the...

AVis formed as the deep dermal suture exits from the wound, and the suture is pulled so that the short (non-needle bearing end) is about 2 cm long. Both strands of suture should come out on the same side of the loop, and the order must be: loop,...

Two loops are placed around the needle holder to initiate the first throw. The short end of the suture is then grasped, and the hand holding the long(needle bearing) end of the suture crosses over the hand with the needle holder.